Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 6200A | WY |
NPI | 1013968304 |
---|---|
Provider Name | Philip Mcmahill |
First Address | Gillette, WY 82716-3426 |
Second Address | Gillette, WY 82716-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 29/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113948700 | (05) | WY |
C63703 | (02) |